The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Abstract

Objective: A comprehensive, multiround survey of local food systems in a rickets-endemic area of Bangladesh was conducted to identify household-level risk factors for rickets. Design: A household-level, case-control study was conducted in a rickets-endemic area, Chakaria, with planned comparisons between households with one or more rachitic child and neighboring households with no affected children. Setting: A rickets-endemic area of southeastern Bangladesh, Chakaria. Subjects and methods: An interview-based survey was conducted in six villages in Chakaria with 199 households with at least one child showing physical signs consistent with rickets and 281 households with no affected children. Results: Households with rachitic children in Chakaria had more children, more pregnant or lactating women, and fewer adults than unaffected households in that community. Affected households tended to rely on farming for their livelihood and tended to have less economic activity as indicated by less outstanding debt than their neighbors. Households with rickets were at significantly greater risk of pneumonia than were other households. Calcium undernutrition was severe and widespread in Chakaria due to a food system that offered very little of the element in accessible forms. Household diets were based on cereals and starchy vegetables. Rice and fish constituted the major source of calcium for most households, although dairy products, when used, were very important calcium sources, particularly for young children. In fact, the use of dairy products was the only household choice that led to substantial increases in the calcium intakes of children, and households that used dairy products tended to show increased calcium intakes for all of their members. Conclusions: The risk of a Chakarian household having a child with rickets appeared to be related to its economic status. Although this might be expected to be manifest as limitations in food access and/or use, rickets households failed to show a dietary pattern associated with rickets. Calcium undernutrition was prevalent and, thus, would appear to be a predisposing factor for rickets; however, calcium undernutrition was prevalent in Chakarian households with and without rickets. Therefore, it is probable that another precipitating factor(s) play a role(s) in the etiology of rickets in Chakaria.

Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi-micronutrient powder formulation

“…These findings are, however, comparable to those from previous studies examining Fe and Ca intake among Bangladeshi children (4,45,46) . Food intake data also revealed a lack of diversity in infant diets, with plant foods based on cereals, vegetables and fruits being the main items consumed.…”

Apparent Efficacy of Food-Based Calcium Supplementation in Preventing Rickets in Bangladesh

“…Because leg signs are seen in only about 47% of cases [18], these results suggest an overall rickets prevalence approaching 4%. In Chakaria, we found that nearly one third of households had a rachitic child [20].…”

“…In recent years, rickets has been reported in at least 21 countries including Bangladesh where it appears to be most prevalent in Cox's Bazar District of southeastern Bangladesh [18][19][20]. The Bangladesh Institute of Mother and Child Health reported that 9% of children examined in Chakaria sub-district presented with one or more rachitic signs including varus and valgus deformities of the knees, sabre tibiae, swollen wrists and joints, pectus carinum, and difficulty walking, with 11% of that number also showing active rickets elevated serum alkaline phosphatase (AP) activities [18].…”

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

“…Evidence primarily from developing countries demonstrates that traditional diets low in calcium cause NR [30,43,69,93,[112][113][114] . Therefore, special diets during infancy such as those that avoid milk and dairy products, those using soy or rice milk that are not specifically designed for infants, and/or vegan and macrobiotic diets may predispose infants to NR [115][116][117][118][119][120] .…”